19 research outputs found

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

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    This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

    The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

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    AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

    Measurement of in-plane displacement fields by a spectral phase algorithm applied to numerical speckle photography for microtensile tests

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    International audienceThis paper describes a numerical method applied to speckle photography to measure the inplane displacement field on a thin film and specially adapted to microtensile test. Speckle photography is chosen to avoid touching and stressing the specimen. A Spectral Phase Algorithm particularly useful in the case of small displacement or/and strain is compared with the Intercorrelation and Double FFT methods. A final algorithm using first the Intercorrelation method without interpolation and secondly the Spectral Phase Algorithm is then adopted to estimate with good accuracy the in-plane displacement field in quasi-real time during the microtensile tests. A first application of the method to the tensile tests performed on thin films of electroplated copper of 18, 35 and 70 ”m of thickness is then presented

    Measurement of in-plane displacement fields by a spectral phase algorithm applied to numerical speckle photography for microtensile tests

    No full text
    International audienceThis paper describes a numerical method applied to speckle photography to measure the inplane displacement field on a thin film and specially adapted to microtensile test. Speckle photography is chosen to avoid touching and stressing the specimen. A Spectral Phase Algorithm particularly useful in the case of small displacement or/and strain is compared with the Intercorrelation and Double FFT methods. A final algorithm using first the Intercorrelation method without interpolation and secondly the Spectral Phase Algorithm is then adopted to estimate with good accuracy the in-plane displacement field in quasi-real time during the microtensile tests. A first application of the method to the tensile tests performed on thin films of electroplated copper of 18, 35 and 70 ”m of thickness is then presented

    Mise en Ɠuvre de deux mĂ©thodes interfĂ©romĂ©triques pour la caractĂ©risation mĂ©canique des films minces par l'essai de gonflement. Applications au cas du silicium monocristallin

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    Holographic interferometry and contouring are two optical methods used to the characterization of mechanical properties of thin films. Therefore, a phase measurement interferometry applied to these methods is exposed. These solutions are discussed in terms of accuracy and sensibility. An application on a bulge test, widely used in micro-mechanic studies, is proposed and experimental results on single crystal silicon thin films are compared with finite element calculations. In each case, the good agreement between theory and experiments allows to valid the apparatus.Deux méthodes optiques sont présentées, interférométrie holographique en temps réel et méthode par projection de franges, appliquées à la caractérisation mécanique des films minces. Ces deux méthodes sont couplées à l'interférométrie par mesure de phase, ce qui permet d'accéder au champ des déplacements en tous points de la membrane. Les solutions retenues sont discutées en termes de précision et de sensibilité. Nous proposons l'application de ces méthodes à l'essai de gonflement de membrane, essai largement répandu dans les études de micro-mécaniques. Les mesures sont effectuées sur du silicium monocristallin et les résultats sont comparés aux solutions calculées par éléments finis. Le bon accord entre théorie et expériences valide les méthodes et les dispositifs développés
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